PASADENA AREA COMMUNITY COLLEGE DISTRICT
EQUAL EMPLOYMENT OPPORTUNITY SURVEY
This form is voluntary and will be kept separate from your application materials.
Name ____________________________________________________________________________
Position __________________________________________________________________________
Superintendent/President
Gender
Male Female I choose not
to respond
Race: If not Hispanic or Latino, please select one of the following race categories.
American Indian or
Alaskan Native
African American or
Black
(Not Hispanic)
Asian Indian Cambodian
Central American Chinese Filipino Guamanian
Hawaiian Japanese Korean
Laotian
Other Asian Other Pacific Islander Samoan South American
Vietnamese White (Not Hispanic)
I choose not to respond
Ethnicity
Are you Hispanic or Latino?
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin,
regardless of race.
No, not Hispanic or Latino Yes, Hispanic or Latino I choose not
to respond
Disability Status:
(Please choose one of the options below if it describes your disability status)
Disabled - An
individual with a disability is a person who has a physical or mental impairment that
substantially limits one or more major life activities, has a record of such impairment, or is regarded as
having such an impairment. Major life activities are activities that the average person can perform with
little or no difficulty such as walking, breathing, seeing, hearing, speaking, learning, and working.
Disabled Requiring Reasonable Accommodation I am not disabled I choose not to respond
Veteran:
I am a veteran I am not a veteran I choose no
t to respond
Have you ever been convicted, including Nolo Contendere please, of a crime (other than minor traffic
violations)? Convictions will not necessarily disqualify you from employment.
No Yes
Where did you hear of this job opportunity?
